Healthcare Provider Details

I. General information

NPI: 1629393699
Provider Name (Legal Business Name): YAHEL WEINSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

300 TANO RD
SANTA FE NM
87506-8822
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3361
  • Fax:
Mailing address:
  • Phone: 917-971-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301110223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: